Deciding Between Total and Subtotal Thyroidectomy: A Guide for Patients with One-Sided Thyroid Cancer or Thyroid Nodules
- Ebrahim Yusuf
- Nov 10, 2024
- 4 min read
When faced with a thyroid condition, such as thyroid cancer or a significant thyroid nodule, surgery may be recommended. Depending on the extent of the disease, your endocrinologist might suggest either a total thyroidectomy (removal of the entire thyroid gland) or a subtotal thyroidectomy (partial removal, often one lobe or a portion of the gland). Deciding between these two procedures can feel overwhelming, but understanding the differences and the factors that influence the choice can help you make an informed decision.
Read our blog post on everything you to know about the procedure of thyroidectomy here...
Understanding the Procedures
Total Thyroidectomy: In this procedure, the entire thyroid gland is removed. It is often recommended for cancers and thyroid nodules that affect both sides of the thyroid or are aggressive. After the surgery, you will require lifelong thyroid hormone replacement therapy since your body will no longer produce these hormones.
Subtotal Thyroidectomy involves removing only a portion of the thyroid, usually the affected lobe. The remaining part of the thyroid may still produce hormones, and depending on the functionality of the remaining tissue, you may or may not need thyroid hormone replacement therapy.
When is Total Thyroidectomy Recommended?
Multifocal or Aggressive Thyroid Cancer: If you have thyroid cancer that affects both sides of the thyroid gland or is aggressive (such as medullary or anaplastic thyroid cancer), a total thyroidectomy is typically the best approach. This allows the surgeon to remove all potentially cancerous tissue and minimize the risk of recurrence.
Large Tumors (>4 cm): Larger thyroid cancers or thyroid nodules are often treated with total thyroidectomy, especially if they show signs of aggressive growth or are at risk of spreading to other parts of the body.
High Risk of Spread (Metastasis): If the cancer has spread to nearby lymph nodes or other distant organs, a total thyroidectomy allows for more comprehensive management.
Family History of Thyroid Cancer: If there is a strong family history of thyroid cancer or genetic mutations that predispose to multiple endocrine neoplasia (MEN), removing the entire gland may be more prudent.
When is Subtotal Thyroidectomy Preferred?
Benign Nodules or Low-Risk Cancer: If you have a benign thyroid nodule or small, localized thyroid cancer (especially papillary or follicular cancer confined to one side), a subtotal thyroidectomy may be sufficient. This approach preserves part of the thyroid, reducing the need for lifelong hormone replacement.
Unilateral Thyroid Cancer: For cancers confined to one lobe of the thyroid with no signs of spread, a subtotal thyroidectomy may be a safe and effective option. The remaining part of the thyroid can often produce hormones, and your hormone levels may remain normal after the surgery.
Desire to Avoid Lifelong Medication: Some patients prefer subtotal thyroidectomy to avoid taking thyroid hormone replacement for the rest of their lives. However, it's important to note that, even after a partial thyroidectomy, there’s still a chance that you may need hormone supplements.
Key Factors to Consider
Several factors influence the decision between total and subtotal thyroidectomy:
Tumor Size and Location: If the tumour is small and located in one lobe, subtotal thyroidectomy is a viable option. However, if the cancer involves multiple areas or is large, total thyroidectomy may be recommended.
Spread to Lymph Nodes: In cases where cancer has spread to nearby lymph nodes, total thyroidectomy is often paired with lymph node dissection to reduce the chance of recurrence.
Risk of Recurrence: Total thyroidectomy is often considered for higher-risk cases to minimize the risk of cancer recurrence. This also makes post-surgery monitoring with radioactive iodine treatment easier, as there’s no remaining thyroid tissue to interfere with the treatment.
Thyroid Function After Surgery: Patients undergoing subtotal thyroidectomy can maintain normal thyroid function post-surgery. On the other hand, those opting for total thyroidectomy will need to take thyroid hormone replacement therapy for life.
Post-Surgical Considerations
Thyroid Hormone Replacement: After a total thyroidectomy, thyroid hormone replacement therapy is necessary to maintain normal metabolic function. This involves taking a daily pill (levothyroxine) to replace the hormones your thyroid used to produce.
Monitoring for Recurrence: After either surgery, you will need to follow up with your endocrinologist regularly. In the case of total thyroidectomy, post-surgical monitoring typically includes periodic blood tests and possibly radioactive iodine scans to check for any remaining cancer cells. For subtotal thyroidectomy, regular ultrasounds may be required to monitor the remaining thyroid tissue.
Complications and Risks: Both surgeries carry risks, including injury to the vocal cords, calcium imbalances due to damage to the parathyroid glands, and bleeding or infection. However, the risks of these complications are generally low in experienced hands.
Making the Right Choice
The decision between total and subtotal thyroidectomy should be made in consultation with your endocrinologist and surgeon. Here are some questions to consider asking your thyroid doctor:
What is the size and location of my tumour or nodule?
Is there evidence of cancer spreading to the lymph nodes or other organs?
What is my risk of recurrence if I choose subtotal thyroidectomy?
Will I need thyroid hormone replacement after surgery?
What is the likelihood of needing additional surgeries in the future?
Conclusion
Deciding whether to opt for a total or subtotal thyroidectomy is highly individualized. The best approach depends on your thyroid condition's characteristics, personal health, and preferences. By discussing all the relevant factors with your healthcare team, you can make a decision that aligns with your medical needs and lifestyle.
Remember, there’s no one-size-fits-all solution, and your endocrinologist will guide you through this process to ensure you receive the most appropriate treatment for your thyroid condition.
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